摘要:
目的:评价新型 Fujifilm-超声支气管镜引导下经支气管针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)对肺门/纵隔良恶性病变的诊断价值和安全性。方法前瞻性入组胸部 CT 检查显示纵隔/肺门病变且需行 EBUS-TBNA 操作的患者60例,并随机分为2组:Olympus-EBUS 组和新型 Fujifilm-EBUS 组,每组30例,未采用现场细胞学方法检测。结果60例患者共穿刺143处病变,每例病变的穿刺次数平均为2.18(1~5)次,其中57例(95.00%)通过 TBNA 获得组织学证据。恶性肿瘤39例,良性病变21例,经 EBUS-TBNA 诊断59例,包括原发性肺癌35例、转移性肺癌2例、淋巴瘤2例、结节病9例、肺部炎症3例、肺结核5例、纵隔囊肿2例和反应性增生1例;1例假阴性经 CT 引导下肺穿刺明确诊断为肺良性平滑肌瘤。16例未明确肿瘤类型行免疫组化检查进一步确诊。2组诊断率差异无统计学意义(96.67% vs 100.00%,χ2=0.4022,P =0.6876)。两组间均未见明显并发症。结论新型 Fujifilm-EBUS 内镜在改良了内镜视野和成像质量的基础上,保证了 TBNA 诊断水平,是鉴别胸部良恶性病变的有效手段。%Objective To evaluate characteristics of new Fujifilm-endobronchial ultrasound (EBUS) guidance scope in transbronchial needle aspiration (TBNA).Methods Sixty patients with mediastinal/hilar adenopathy who were referred for EBUS-TBNA were prospectively enrolled and randomly divided into Olympus-EBUS group and new Fujifilm-EBUS group,30 patients in each group. Rapid on-site cytological evaluation was not adopted.Results One hundred forty-three lesions were aspirated in 60 patients,the average aspiration times per target lesion were 2.18(1-5) times.Histology specimen was obtained in 57(95.00%) patients.Thirty-nine malignancies and twenty-one benignancies were finally included.59 patients were diagnosed through EBUS-TBNA,including 35 cases of primary lung cancer,two cases of metastatic lung cancer,two cases of lymphoma,nine cases of sarcoidosis,five cases of tuberculosis,three cases of inflammation,two cases of mediastinal cysts,and one case of reactive hyperplasia.There was one false-negative case,being diagnosed as pulmonary benign leiomyoma by CT-guided transthoracic needle aspiration.For 1 6 malignancies with no definite histologic origin or type, immunohistochemistry was performed to refine diagnosis.There was no significant difference in diagnostic rate between Olympus-EBUS group and new Fujifilm-EBUS group(96.67% vs 100.00%,χ2 =0.402 2, P = 0.687 6).No major complication was observed in two groups.Conclusions New Fujifilm-EBUS-TBNA has the similar diagnostic results with that of CP-EBUS-TBNA.But the endoscopic view of Fujifilm-EBUS scope might make it possible to eliminate the need of a second scope and makes EBUS-TBNA simpler to do and easier to learn.